A Comparison of Nutritional Management with Stress Management in the Treatment of Bulimia Nervosa

1991 ◽  
Vol 159 (2) ◽  
pp. 250-261 ◽  
Author(s):  
R. G. Laessle ◽  
P. J. V. Beumont ◽  
P. Butow ◽  
W. Lennerts ◽  
M. O'Connor ◽  
...  
Keyword(s):  
Bulimia Nervosa ◽  
Binge Eating ◽  
Body Dissatisfaction ◽  
Stress Management ◽  
Eating Behaviour ◽  
Nutritional Management ◽  
Rapid Improvement ◽  
Treatment Conditions ◽  
Psychological Difficulties

In a comparison of nutritional management (NM) and stress management (SM) for treatment of bulimia nervosa, 55 female patients were randomly assigned to either treatment. Therapy consisted of 15 sessions in a group over three months, by the end of which, patients under both treatment conditions showed a significant reduction in the frequency of binge eating and vomiting and a significant improvement in various psychopathological features such as body dissatisfaction and depression. All improvements were maintained over 12–month follow-up. NM produced a more rapid improvement in general eating behaviour, a faster reduction in binge frequency and a higher abstinence rate from binge eating. SM led to greater positive changes in certain psychopathological features such as feelings of ineffectiveness, interpersonal distrust and anxiety. NM should be regarded as a necessary first intervention in all bulimic patients. Further psychological therapy, such as SM, is indicated as well for some patients, depending on their specific psychological difficulties.

Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions: a feasibility trial

2020 ◽  
pp. 1-10
Author(s):  
Rayane Chami ◽  
Valentina Cardi ◽  
Natalia Lawrence ◽  
Pamela MacDonald ◽  
Katie Rowlands ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Implementation Intentions ◽  
Effect Sizes ◽  
Post Intervention ◽  
Eating Frequency ◽  
Eating Disorder Psychopathology

Abstract Background This trial examined the feasibility, acceptability, and effect sizes of clinical outcomes of an intervention that combines inhibitory control training (ICT) and implementation intentions (if-then planning) to target binge eating and eating disorder psychopathology. Methods Seventy-eight adult participants with bulimia nervosa or binge eating disorder were randomly allocated to receive food-specific, or general, ICT and if-then planning for 4 weeks. Results Recruitment and retention rates at 4 weeks (97.5% and 79.5%, respectively) met the pre-set cut-offs. The pre-set adherence to the intervention was met for the ICT sessions (84.6%), but not for if-then planning (53.4%). Binge eating frequency and eating disorder psychopathology decreased in both intervention groups at post-intervention (4 weeks) and follow-up (8 weeks), with moderate to large effect sizes. There was a tendency for greater reductions in binge eating frequency and eating disorders psychopathology (i.e. larger effect sizes) in the food-specific intervention group. Across both groups, ICT and if-then planning were associated with small-to-moderate reductions in high energy-dense food valuation (post-intervention), food approach (post-intervention and follow-up), anxiety (follow-up), and depression (follow-up). Participants indicated that both interventions were acceptable. Conclusions The study findings reveal that combined ICT and if-then planning is associated with reductions in binge eating frequency and eating disorder psychopathology and that the feasibility of ICT is promising, while improvements to if-then planning condition may be needed.

Eating behaviour, eating disorder and obesity

2000 ◽  
Vol 57 (8) ◽  
pp. 504-510 ◽  
Author(s):  
Zipfel ◽  
Löwe ◽  
Herzog
Keyword(s):  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Eating Behaviour ◽  
Diagnostische Kriterien ◽  
Affektive Störungen ◽  
Therapeutische Optionen ◽  
Dsm Iv

Die Ernährungs- und Bewegungssituation sowie die sozioökonomischen Umstände haben sich in den vergangenen 50 Jahren in den entwickelten Ländern radikal gewandelt. Folgen dieser Entwicklung sind rasante Steigerungen der Prävalenzraten, insbesondere der Adipositas. Kontrastierend hierzu wird weiterhin ein ausgeprägtes Schlankheitsideal propagiert. Dieses Spannungsfeld ist mitverantwortlich für eine steigende Inzidenz von Essstörungen. Hierzu gehören im Gewichtsspektrum des Normal- bis Übergewichtes die Bulimia nervosa und die Esssucht, bisher noch mit dem englischen Begriff der «Binge-Eating-Disorder» bezeichnet. Obwohl die Bulimia Nervosa bereits 1980 in die DSM-III Kriterien aufgenommen wurde, ergaben Untersuchungen, dass bislang nur etwa 12 Prozent der Betroffenen von den Hausärzten entdeckt und richtig diagnostiziert werden. Ein Grund dieser erschreckend niedrigen Zahl liegt in der Dynamik der Erkrankung, mit einer ausgeprägten Tendenz der Patientinnen zur Verheimlichung, ein weiterer Grund mag in einer noch unzureichenden Aufklärung der Hausärzte liegen. Deshalb werden diagnostische Kriterien und therapeutische Optionen dargestellt. Essstörungen im Bereich des Übergewichtes werden seit dem DSM-IV (1994) im Wesentlichen unter dem Begriff der «Binge-Eating-Disorder (BED)» zusammengefasst. 20–30% der adipösen Patienten, die sich in Gewichtsreduktionsprogrammen befinden, leiden unter dieser Essstörung. Erste Untersuchungsergebnisse zeigen, dass diese Subgruppe der Adipösen eine modifizierte Behandlung mit einer stärkeren Fokussierung auf eine Psychotherapie bedarf. Über die initiale Abklärung einer möglichen Essstörung hinaus sollten auch affektive Störungen (Depressivität und Ängstlichkeit) oder ein gestörtes Körperbild erfasst werden. Falls Hinweise auf eine ausgeprägte Störung in diesen Bereichen vorliegen, sollte Psychotherapie fester Bestandteil eines integrierten Therapiekonzeptes der Adipositas sein.

scholarly journals Managing Risk of Non-Communicable Diseases in Women with Bulimia Nervosa or Binge Eating Disorders: A Randomized Trial with 12 Months Follow-Up

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 1887 ◽  
Author(s):  
Therese Mathisen ◽  
Jorunn Sundgot-Borgen ◽  
Jan Rosenvinge ◽  
Solfrid Bratland-Sanda
Keyword(s):  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Physical Fitness ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Communicable Diseases ◽  
Post Treatment ◽  
Dietary Therapy ◽  
Non Communicable Diseases

Persons with bulimia nervosa (BN) or binge eating disorder (BED) have an elevated risk of non-communicable diseases (NCDs). However, lowering this risk is rarely addressed in standard cognitive-behavioral treatment (CBT). We aimed to compare CBT with an intervention combining physical exercise and dietary therapy (PED-t), and hypothesized that the PED-t would do better than CBT in lowering the risk of NCD both initially and longitudinally. In this study, 164 women with bulimia nervosa or binge eating disorder were randomly assigned to 16-weeks of outpatient group therapy with either PED-t or CBT. Body composition (BC) was measured by dual-energy X-ray absorptiometry. Measures of physical fitness (VO2peak and one repetition maximum (1RM) in squats, bench press, and seated row) were also recorded. All measurements were completed baseline, post-treatment, and at 6- and 12-month follow-ups, respectively. Our results showed that PED-t improved more than CBT on mean (99% CI) absolute Vo2peak; 57,2 (84.4, 198.8) mL (g = 0.22, p < 0.001) post-treatment. There were small to medium long-term differences in 1RM after PED-t compared to CBT. BC deteriorated in both groups during follow-up. Neither the PED-t nor the CBT lowered the risk for NCDs. Clearly, other approaches need to be considered to promote physical fitness and lower the risk of NCDs among individuals with BN and BED.

Psvchotheraw and bulimia nervosa: eviluation and long-term follow-up of two conflict-orientated treatment conditions

1996 ◽  
Vol 93 (4) ◽  
pp. 268-278 ◽  
Author(s):  
B. Jäger ◽  
R. Liedtke ◽  
H.-W. Künsebeck ◽  
W. Lempa ◽  
A. Kersting ◽  
...  
Keyword(s):  
Bulimia Nervosa ◽  
Treatment Conditions ◽  
Long Term Follow Up

Guided self-help for bulimia nervosa in primary care: a randomized controlled trial

2005 ◽  
Vol 35 (9) ◽  
pp. 1283-1294 ◽  
Author(s):  
SUSAN J. BANASIAK ◽  
SUSAN J. PAXTON ◽  
PHILLIPA HAY
Keyword(s):  
Primary Care ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Psychological Symptoms ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Sample Treatment ◽  
Self Help ◽  
Treatment Gains

Background. To increase access to cognitive behavioural therapy for bulimia nervosa new delivery modes are being examined. Guided Self-Help (GSH) in primary care is potentially valuable in this respect. This research aimed to compare outcomes following GSH delivered by general practitioners (GPs) in the normal course of their practice to a delayed treatment control (DTC) condition, and to examine the maintenance of treatment gains at 3 and 6 months following completion of GSH.Method. Participants were 109 women with full syndrome or sub-threshold bulimia nervosa, randomly allocated to GSH (n=54) and DTC (n=55). The GSH group received direction and support from a GP over a 17-week period while working through the manual in Bulimia Nervosa and Binge-Eating: A Guide to Recovery by P. J. Cooper (1995). GSH and DTC groups were assessed pre-treatment and 1 week following the 17-week intervention or waiting interval. The GSH group was reassessed at 3- and 6-month follow-up.Results. Intention-to-treat analyses at end of treatment revealed significant improvements in bulimic and psychological symptoms in GSH compared with DTC, reduction in mean frequency of binge-eating episodes by 60% in GSH and 6% in DTC, and remission from all binge-eating and compensatory behaviours in 28% of the GSH and 11% of the DTC sample. Treatment gains were maintained at 3- and 6-month follow-up.Conclusion. Outcomes in GSH compare favourably with those of specialist-delivered psychological treatments. These findings are considered in light of the nature of the therapy offered and the primary care context.

Serotonergic dysfunction across the eating disorders: relationship to eating behaviour, purging behaviour, nutritional status and general psychopathology

2000 ◽  
Vol 30 (5) ◽  
pp. 1099-1110 ◽  
Author(s):  
P. MONTELEONE ◽  
F. BRAMBILLA ◽  
F. BORTOLOTTI ◽  
M. MAJ
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Nutritional Status ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
High Frequency ◽  
Eating Behaviour ◽  
Plasma Prolactin ◽  
Prolactin Response

Background. Several recent studies have pointed to a dysfunction of serotonin transmission in patients with eating disorders. Notwithstanding, it is not known whether serotonergic abnormalities are related primarily to eating and/or purging behaviour, nutritional status or general psychopathological dimensions. Therefore, by using a validated neuroendocrine strategy, we investigated central serotonergic function in patients with anorexia nervosa, bulimia nervosa or binge-eating disorder who differ on the above parameters.Methods. Plasma prolactin response to D-fenfluramine (30 mg p.o.) or placebo was measured in 58 drug-free female volunteers, comprising 15 underweight anorexic women, 18 bulimic women, 10 women with binge-eating disorder and 15 female healthy controls. Behavioural assessment included ratings of eating disorder symptoms, depression, aggression and food-related obsessions and compulsions.Results. A significantly decreased prolactin response to D-fenfluramine was found in underweight anorexic women and in bulimics with high frequency bingeing ([ges ]2 binge episodes/day), but not in patients with binge-eating disorder or in bulimics with low frequency bingeing ([les ]1 binge episode/day). In the whole bulimic group, a negative correlation emerged between frequency of bingeing and prolactin response. No significant correlation was found between physical or psychopathological measures and the hormonal response in any group.Conclusions. These results confirm our previous findings of an impaired serotonergic transmission in underweight anorexics and in bulimics with high frequency bingeing, but not in patients with less severe bulimia nervosa. Moreover, they show, for the first time, that the hypothalamic serotonergic system is not altered in women with binge-eating disorder.

Ghrelin and leptin responses to food ingestion in bulimia nervosa: implications for binge-eating and compensatory behaviours

2003 ◽  
Vol 33 (8) ◽  
pp. 1387-1394 ◽  
Author(s):  
P. MONTELEONE ◽  
V. MARTIADIS ◽  
M. FABRAZZO ◽  
C. SERRITELLA ◽  
M. MAJ
Keyword(s):  
Bulimia Nervosa ◽  
Binge Eating ◽  
Eating Behaviour ◽  
Food Ingestion ◽  
Sample Collection ◽  
Healthy Women ◽  
Peripheral Proteins ◽  
Plasma Leptin ◽  
Bulimic Women

Background. Ghrelin and leptin are endogenous peripheral proteins involved in the regulation of eating behaviour. In particular, ghrelin stimulates hunger and promotes food ingestion, whereas leptin increases satiety and reduces food consumption. Therefore, alterations in the physiology of these peptides may play a role in the pathogenesis of eating disorders such as bulimia nervosa. In the present study, we investigated ghrelin and leptin responses to food ingestion in patients with bulimia nervosa.Method. Nine symptomatic drug-free bulimic women and 12 age-matched healthy women ingested a meal of 1207 kcal (60% carbohydrates, 23% fat and 17% proteins) at 12.00 a.m. and underwent blood sample collection before and 45, 60, 90, 120 and 180 min after the meal. Plasma levels of ghrelin, leptin, insulin and glucose were measured.Results. In healthy women, circulating ghrelin exhibited a drastic decrease after the food intake whereas, in bulimic patients, this response was significantly blunted. No difference between the two subjects groups was observed in post-prandial profiles of plasma leptin, insulin and glucose.Conclusions. The lack of a leptin response to food ingestion, in both bulimic and healthy women, is compatible with the role of this peptide as long-term rather than short-term modulator of eating behaviour. The blunted ghrelin response to food ingestion may support the occurrence in bulimic subjects of an impaired suppression of the drive to eat following a meal. This may have implications for binge-eating.

A Placebo-Controlled Trial of d-Fenfluramine in Bulimia Nervosa

1993 ◽  
Vol 162 (5) ◽  
pp. 597-603 ◽  
Author(s):  
Thomas A. Fahy ◽  
Ivan Eisler ◽  
Gerald F. M. Russell
Keyword(s):  
Bulimia Nervosa ◽  
Controlled Trial ◽  
Eating Behaviour ◽  
Behavioural Therapy ◽  
Carbohydrate Consumption ◽  
Cognitive Behavioural ◽  
Abnormal Eating ◽  
Food Diaries ◽  
Therapy Treatment

d-Fenfluramine is a 5-HT agonist which decreases food intake and excessive carbohydrate intake in humans. A placebo-controlled trial of d-fenfluramine (45 mg/day) was conducted in 43 patients with bulimia nervosa. The patients entered an eight-week trial of medication during which they also received cognitive-behavioural therapy. Treatment response was assessed using food diaries to record eating behaviour, and self-rating questionnaires to measure psychopathology. The drug trial, and a follow-up assessment after a further eight weeks, were completed by 39 patients. Abnormal eating behaviour and psychopathology improved significantly in both the d-fenfluramine and placebo groups during the treatment trial. The study failed to show that the addition of d-fenfluramine affords an advantage over brief psychotherapy alone. Although d-fenfluramine is effective in suppressing the overeating, excessive snacking, and excessive carbohydrate consumption which are frequently found in overweight or obese patients, this study suggests that the drug is not an effective treatment for bulimia nervosa.

Elevated total plasma-adiponectin is stable over time in young women with bulimia nervosa

2017 ◽  
Vol 41 (1) ◽  
pp. 30-36 ◽  
Author(s):  
M. Syk ◽  
M. Ramklint ◽  
R. Fredriksson ◽  
L. Ekselius ◽  
J.L. Cunningham
Keyword(s):  
Morbid Obesity ◽  
Eating Disorder ◽  
Bulimia Nervosa ◽  
Symptom Severity ◽  
Eating Behaviour ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Plasma Adiponectin ◽  
Eating Disorder Examination

AbstractBackgroundBulimia nervosa (BN) is characterized by dysregulated eating behaviour and present data suggest adipokines may regulate food intake. We investigated a possible association between BN and adipokine levels and hypothesized that plasma (P)-adiponectin would be elevated and P-leptin and P-leptin-adiponectin-ratio would be reduced in women with BN.MethodsThe study was designed as a cross-sectional study with a longitudinal arm for patients with BN. Plasma-adiponectin and leptin was measured in 148 female patients seeking psychiatric ambulatory care and 45 female controls. Fifteen patients were diagnosed with BN and the remaining with other affective and anxiety disorders. P-adiponectin and P-leptin levels were compared between patients with BN, patients without BN and controls. At follow-up 1–2 years later, adipokines were reassessed in patients with BN and the Eating Disorder Examination Questionnaire was used to assess symptom severity.ResultsP-adiponectin was elevated in patients with BN at baseline and at follow-up when compared to patients without BN and controls (P < 0.004 and < 0.008 respectively). The difference remained significant after controlling for body mass index. P-adiponectin was correlated to symptom severity at follow-up in patients with BN without morbid obesity (ρ = 0.72, P < 0.04). P-leptin-adiponectin-ratio was significantly lower in patients with BN compared to controls (P < 0.04) and P-leptin non-significantly lower.ConclusionsFindings indicate a stable elevation of P-adiponectin in women with BN. P-adiponectin at follow-up correlates to eating disorder symptom severity in patients without morbid obesity, indicating that P-adiponectin should be further investigated as a possible potential prognostic biomarker for BN.

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